Criteria for rejection of specimens Criteria should be developed by a laboratory on the basis of which the processing of a specimen may

not be done by the laboratory. The following are some examples: Missing or inadequate identification. Insufficient quantity. pecimen collected in an inappropriate container. Contamination suspected. Inappropriate transport or storage. !n"nown time delay. #aemolysed blood sample.

Collection of specimens The clinical state of the patient will not necessarily be reflected by the result of laboratory investigation despite correct laboratory performanceunless the specimen is in optimal condition required for the analysis. ome of the important specimens and their proper collection and transportation methods are described here so as to ensure quality. $lood %hole blood is required for bacteriological examination. erum separated from blood is used for serological techniques. "in antisepsis is extremely important at the time of collection of the sample. Tincture of iodine &'()*+, povidone iodine &'-*+ and chlorhexidine &-..* in /-* alcohol+ are ideal agents. #owever, some individuals may be hypersensitive to iodine present in some of these. %hile collecting blood for culture,the following points must be remembered: Collect blood during the early stages of disease since the number of bacteria in blood is higher in the acute and early stages of disease. Collect blood during paroxysm of fever since the number of bacteria is higher at high temperatures in patients with fever.

In the absence of antibiotic administration, 00* culture positivity can be seen with three blood cultures. mall children usually have higher number of bacteria in their blood as compared to adults and hence less quantity of blood needs to be collected from them &Table )+. Table ): 1olume of blood to be collected at different ages

2ge 3 ) years )(. years 5('- years 6'- years

1olume in ) bottles ) ml 4 ml ') ml )- ml

Cerebrospinal fluid &C 7+ 8xamination of C 7 is an essential step in the diagnosis of any patient with evidence of meningeal irritation or affected cerebrum. 2lmost 9('- ml of C 7 is collected and part of it is used for biochemical, immunological and microscopic examination and remaining for bacteriological or fungal examination. The following important precautions need to be ta"en for C 7 collection and transportation: Collect C 7 before antimicrobial therapy is started. Collect C 7 in a screw : capped sterile container and not in an injection vial with cotton plug. ;o not delay transport and laboratory investigations. Transport in a transport medium if delay in processing is unavoidable. C 7 is a precious specimen, handle it carefully and economically. It may not be possible to get a repeat specimen.

<erform physical inspection immediately after collection and indicate findings on laboratory requisition form. tore at 9/oC, if delay in processing is inevitable. The characteristics of the appearance of C 7 are outlined in Table 9. Table 9: 2ppearance and interpretations of C 7

Clear and colourless

=ormal

Clear with Tyndall effect #igh protein content &spar"ling appearance against incident light+ Clear yellowish Clear red Turbid blood(stained Turbid white Turbid clot &after overnight storage+ putum putum is processed in the laboratory for aetiological investigation of bacterial and fungal infections of the lower respiratory tract. It is of utmost importance in the diagnosis of pulmonary tuberculosis. elect a good wide(mouthed sputum container, which is preferably disposable, made of clear thin plastic, unbrea"able and lea" proof material. ?ive the patient a sputum container with the laboratory serial number written on it. how the patient how to open and close the container and explain the importance of not rubbing off the number written on the side of the container. Instruct the patient to inhale deeply )(9 times, cough up deeply from the chest and spit in the sputum container by bringing it closer to the mouth. Ma"e sure the sputum sample is of good quality. 2 good sputum sample is thic", purulent and sufficient in amount &)(9 ml+. >ld haemolysis 7resh haemolysis #aemorrhage #igh cell or protein content 7ibrin clots

?ive the patient an additional container with laboratory serial number written on it for an early morning specimen. 8xplain to the patient to rinse his@her mouth with plain water before bringing up the sputum. !rine !nder normal circumstances urine is sterile. The lower part of the urethra and the genitalia are normally colonised by bacteria, many of which may also cause urinary tract infection. ince urine is a good growth medium for all sorts of bacteria, proper and aseptic collection assumes greater importance for this specimen. 7or microbiological examination urine must be collected as a Aclean catch(mid(streamA specimen. !rine specimens should be transported to the laboratory within one hour for bacteriological examination, because of the continuous growth of bacteria in vitro thus altering the actual concentration of organisms. tool 7aecal specimens for the aetiological diagnosis of acute infectious diarrheaBs should be collected in the early stage of illness and prior to treatment with antimicrobials. 2 stool specimen rather than a rectal swab is preferred. The 7aeces specimen should not be contaminated with urine. ;o not collect the specimen from bed pan. Collect the specimen during the early phase of the disease and as far as possible before the administration of antimicrobial agents. ' to ) gm quantity is sufficient. If possible, submit more than one specimen on different days. The fresh stool specimen must be received within '() hours of passage. tore at )(4oC. Modified Cary and $lair medium is recommended as a good transport medium. It is a very stable medium and can be stored for use in screw : capped containers. It is a semi( solid transport medium. 2t least two swabs should be inoculated. Most pathogens will survive for up to C4 hours at room temperature. pecimens are unacceptable if the medium is held for more than one wee" or if there is detectable drying of the specimen.

2lternative transport media are 1en"ataraman(Dama"rishnan medium &1(D fluid+ or al"aline peptone water. 1D fluid should be prepared in 9- ml &' oE+ screw capped bottles &MacCartney bottles+. It preserves vibrios for more than six wee"s and has also proved to be a very convenient medium for transportation as it can be "ept at room temperature after collection of the specimen. Transportation of specimens pecimens to be sent to other laboratories require special attention for safe pac"ing of the material. ?uidelines are usually issued by national authorities and the same should be strictly followed. 7or hand(carried transportation over a short distance, the specimen should be placed upright in appropriate rac"s. 7or long distance transportation, it should be placed in three containers, i.e: 2 primary container which has the specimen and is lea" proof with a screw(cap. 2 secondary container which is durable, waterproof and made of metal or plastic with a screw(cap. It should have enough absorptive material to absorb the contents of the primary container should the latter brea" or lea". >n its outside, the details of the specimen should be pasted. 2 tertiary container is usually made of wood or card box. It should be capable of withstanding the shoc"s and trauma of transportation. ;ry ice can be "ept between this and the secondary container along with sufficient absorbents and provision for the escape of carbon dioxide to prevent a pressure build(up inside. In general, most specimens should be processed in the laboratory within ' to ) hours after collection. In practice, a )(to C(hour time limit is probably more practical during a normal wor"ing day. The laboratory must be organiEed to permit processing of the specimens as soon as they arrive, and the collection of most specimens should be limited to the wor"ing hours of the laboratory. #owever, some arrangements must be made to allow for the initial handling of the few specimens that have to be collected outside of the laboratoryBs wor"ing hours.